Healthcare Provider Details

I. General information

NPI: 1558290858
Provider Name (Legal Business Name): CREATIVE COMPASS AND COLLABORATIVE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CLEVELAND AVE STE 303
ISHPEMING MI
49849-1842
US

IV. Provider business mailing address

308 CLEVELAND AVE STE 303
ISHPEMING MI
49849-1842
US

V. Phone/Fax

Practice location:
  • Phone: 906-204-2069
  • Fax: 906-451-5455
Mailing address:
  • Phone: 906-204-2069
  • Fax: 906-451-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE K NELSON
Title or Position: OWNER
Credential: LMSW, CAADC
Phone: 906-204-2069